Keil Fee, Hagemes Frank, Setzer Matthias, Behmanesh Bedjan, Marquardt Gerhard, Hattingen Elke, Prinz Vincent, Czabanka Marcus, Bruder Markus
Institute of Neuroradiology, University hospital Frankfurt, 60528 Frankfurt am Main, Germany.
Department of Neurosurgery, University hospital Frankfurt, 60528 Frankfurt am Main, Germany.
J Clin Med. 2024 Sep 25;13(19):5690. doi: 10.3390/jcm13195690.
The accurate identification of intraoperative levels is of paramount importance in spinal surgery, particularly in cases of obesity or anatomical anomalies affecting the thoracic spine. The aim of this work was to clarify whether the preoperative percutaneous placement of fiducial markers under local anesthesia only, with minimal discomfort to the patient, can be performed safely and efficiently. Patients treated at our institution between June 2019 and June 2020 for thoracic intraspinal lesions with preoperative percutaneous gold fiducial placement were analyzed. A total of 10 patients underwent CT-guided gold fiducial placement 2-48 h prior to surgery on an outpatient or inpatient basis. Patient characteristics, CT intervention time, and perioperative complications were recorded. In all cases, the gold markers were placed under local anesthesia alone and were easily visualized intraoperatively with fluoroscopy. There was no preoperative dislocation or malposition. The procedure was performed without X-ray exposure to the neuroradiology interventionalist. The average CT intervention time from the planning scout to the final control time was 14.3 min. The percentage of anatomical norm variants in our observation group was high, as 2 of the 10 patients had lumbarization of the first sacral vertebra, resulting in a six-link lumbar spine. Preoperative CT-guided transcutaneous submuscular placement of gold markers under local anesthesia is a practical and safe method for rapid and accurate intraoperative level determination in thoracic spine surgery in a time-saving minimally invasive manner. The virtually painless procedure can be performed either preoperatively on an outpatient basis or as an inpatient procedure.
在脊柱手术中，准确识别术中节段至关重要，尤其是在肥胖患者或影响胸椎的解剖结构异常的情况下。本研究的目的是明确仅在局部麻醉下术前经皮放置基准标记物，对患者造成最小不适，是否能够安全有效地进行。对2019年6月至2020年6月期间在我院接受治疗的胸椎椎管内病变患者进行分析，这些患者术前均经皮放置了金基准标记物。共有10例患者在门诊或住院期间于手术前2 - 48小时接受了CT引导下的金基准标记物放置。记录患者特征、CT干预时间和围手术期并发症。在所有病例中，金标记物仅在局部麻醉下放置，术中通过透视很容易看到。术前没有移位或位置不当的情况。该操作在没有神经放射介入医生接受X射线照射的情况下进行。从计划扫描到最终对照时间的平均CT干预时间为14.3分钟。我们观察组中解剖结构正常变异的比例较高，因为10例患者中有2例第一骶椎腰化，形成了六节段腰椎。术前在局部麻醉下经CT引导经皮在肌肉下放置金标记物，是一种实用且安全的方法，可在胸椎手术中以节省时间的微创方式快速准确地确定术中节段。这种几乎无痛的操作既可以在术前作为门诊手术进行，也可以作为住院手术进行。
